Medicare Quality Improvement Contract Awarded to Ohio Kepro for $72.9M to Enhance Beneficiary Healthcare Services
Contract Overview
Contract Amount: $72,880,805 ($72.9M)
Contractor: Ohio Kepro, LLC
Awarding Agency: Department of Health and Human Services
Start Date: 2014-05-08
End Date: 2019-09-07
Contract Duration: 1,948 days
Daily Burn Rate: $37.4K/day
Competition Type: FULL AND OPEN COMPETITION
Number of Offers Received: 1
Pricing Type: COST PLUS FIXED FEE
Sector: Healthcare
Official Description: IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, QUALITY OF CARE REVIEWS, BENEFICIARY COMPLAINT REVIEWS, DISCHARGE AND TERMINATION OF SERVICE APPEALS IN VARIOUS PROVIDER SETTINGS, MEDICAL NECESSITY REVIEWS, AND EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) REVIEWS.AREA 2PERIOD OF PERFORMANCE: MAY 6, 2014 - MAY 5, 2019
Place of Performance
Location: SEVEN HILLS, CUYAHOGA County, OHIO, 44131
State: Ohio Government Spending
Plain-Language Summary
Department of Health and Human Services obligated $72.9 million to OHIO KEPRO, LLC for work described as: IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, … Key points: 1. Contract aims to improve healthcare for Medicare beneficiaries through quality reviews and complaint handling. 2. Ohio Kepro, LLC secured the contract, indicating a specific provider focus. 3. The contract period spans five years, from May 2014 to May 2019. 4. Services include quality of care reviews, appeals, and medical necessity assessments. 5. The contract falls under 'Other Management Consulting Services' (NAICS 541618).
Value Assessment
Rating: fair
The contract value of $72.9 million over five years suggests a significant investment in quality improvement. Benchmarking against similar QIO contracts would be necessary for a precise value assessment, but the scope of services indicates a substantial program.
Cost Per Unit: N/A
Competition Analysis
Competition Level: full-and-open
The contract was awarded through full and open competition, suggesting a robust price discovery process. This method allows multiple qualified vendors to bid, potentially leading to more competitive pricing.
Taxpayer Impact: The investment aims to improve healthcare quality, which could lead to long-term cost savings through better patient outcomes and reduced hospitalizations, ultimately benefiting taxpayers.
Public Impact
Improved healthcare quality for Medicare beneficiaries. Enhanced review processes for beneficiary complaints and appeals. Potential for reduced healthcare costs through better care management. Ensured compliance with statutory review functions for healthcare providers.
Waste & Efficiency Indicators
Waste Risk Score: 50 / 10
Warning Flags
- Contract duration is lengthy (5 years).
- Cost Plus Fixed Fee contract type can incentivize cost overruns if not managed tightly.
- Specific performance metrics and outcomes are not detailed in the provided data.
Positive Signals
- Awarded through full and open competition.
- Clear statutory purpose for improving healthcare quality.
- Contract awarded to a single entity for focused execution.
Sector Analysis
This contract falls within the healthcare services sector, specifically focusing on quality improvement for Medicare beneficiaries. Spending in this area is critical for ensuring the efficiency and effectiveness of government healthcare programs.
Small Business Impact
The provided data does not indicate any specific set-asides or participation goals for small businesses in this contract. Further investigation would be needed to determine small business involvement.
Oversight & Accountability
The contract's purpose aligns with CMS's oversight responsibilities for Medicare quality. The effectiveness of oversight would depend on the performance metrics and reporting mechanisms established within the contract.
Related Government Programs
- Other Management Consulting Services
- Department of Health and Human Services Contracting
- Centers for Medicare and Medicaid Services Programs
Risk Flags
- Potential for cost overruns with Cost Plus Fixed Fee structure.
- Lack of specific performance metrics in the provided data.
- Dependency on a single contractor for critical quality improvement functions.
- The broad NAICS code may obscure the specialized nature of QIO work.
Tags
other-management-consulting-services, department-of-health-and-human-services, oh, definitive-contract, 10m-plus
Frequently Asked Questions
What is this federal contract paying for?
Department of Health and Human Services awarded $72.9 million to OHIO KEPRO, LLC. IGF::CT::IGFTHE PURPOSE OF THE BENEFICIARY AND FAMILY CENTERED CARE (BFCC) QUALITY IMPROVEMENT ORGANIZATION (QIO) CONTRACT IS TO IMPROVE HEALTHCARE SERVICES FOR MEDICARE BENEFICIARIES THROUGH BFCC PERFORMANCE OF NUMEROUS STATUTORY REVIEW FUNCTIONS, INCLUDING, BUT NOT LIMITED TO, QUALITY OF CARE REVIEWS, BENEFICIARY COMPLAINT REVIEWS, DISCHARGE AND TERMINATION OF SERVICE APPEALS IN VARIOUS PROVIDER SETTINGS, MEDICAL NECESSITY REVIEWS, AND EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA)
Who is the contractor on this award?
The obligated recipient is OHIO KEPRO, LLC.
Which agency awarded this contract?
Awarding agency: Department of Health and Human Services (Centers for Medicare and Medicaid Services).
What is the total obligated amount?
The obligated amount is $72.9 million.
What is the period of performance?
Start: 2014-05-08. End: 2019-09-07.
What is the expected return on investment for this contract in terms of improved health outcomes and cost savings?
The expected return on investment is anticipated through improved patient outcomes, reduced hospital readmissions, and more efficient healthcare utilization. Quantifying this requires tracking specific quality metrics and comparing them against baseline data and control groups. The long-term goal is to demonstrate that enhanced quality leads to lower overall healthcare expenditures for Medicare.
What are the key performance indicators (KPIs) used to measure the success of Ohio Kepro, LLC in fulfilling the contract's objectives?
Key performance indicators likely include metrics related to the timeliness and accuracy of quality of care reviews, beneficiary complaint resolution rates, successful appeal processing, and adherence to EMTALA regulations. CMS would monitor these KPIs to ensure Ohio Kepro, LLC is meeting its contractual obligations and effectively improving healthcare services for Medicare beneficiaries.
How does the 'Other Management Consulting Services' classification accurately reflect the scope of work for a Quality Improvement Organization?
While the NAICS code 'Other Management Consulting Services' (541618) is broad, it can encompass the analytical, advisory, and process improvement functions inherent in a QIO's work. QIOs analyze healthcare data, advise providers on quality enhancements, and implement strategies to improve patient care, which aligns with consulting principles, albeit within a highly regulated healthcare context.
Industry Classification
NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Other Management Consulting Services
Product/Service Code: MEDICAL SERVICES › DEPENDENT MEDICARE SERVICES
Competition & Pricing
Extent Competed: FULL AND OPEN COMPETITION
Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE
Offers Received: 1
Pricing Type: COST PLUS FIXED FEE (U)
Evaluated Preference: NONE
Contractor Details
Address: 5700 LOMBARDO CTR STE 100, CLEVELAND, OH, 44131
Business Categories: Category Business, Corporate Entity Not Tax Exempt, Not Designated a Small Business, Special Designations, U.S.-Owned Business
Financial Breakdown
Contract Ceiling: $72,880,805
Exercised Options: $72,880,805
Current Obligation: $72,880,805
Actual Outlays: $998,958
Contract Characteristics
Multi-Year Contract: Yes
Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED
Cost or Pricing Data: YES
Timeline
Start Date: 2014-05-08
Current End Date: 2019-09-07
Potential End Date: 2019-09-07 00:00:00
Last Modified: 2025-03-04
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